CLINICAL QUERIES

Clinical Queries



PICO

The selected topic for this report is “An evidence-based healthcare approach matters to care for patients effectively, improve patient safety and reduce waste”.

Introduction

One could easily argue that the United States has the most advanced healthcare delivery of any country in the world. Per capita we spend roughly $8,000 annually, more of our GDP (16.4% or roughly $2.4 trillion) on healthcare than any country in the world3. Based on our current trajectory, this number is expected to grow to 18.8% of GDP and $11,000 per capita by 2015. We have the most sophisticated teaching hospitals and medical research centers in the world, replete with the most advanced medical equipment on the planet yet we rank 33rd in the global rankings for longevity (tied with Cuba). Earlier in 2009, many Americans were glued to their TVs in fascination regarding the story of a women who delivered eight children as a result of fertility treatments, resulting in premature births, intensive care support in a neonatal facility, and speculation of bills ranging from half a million to $3.5 million4; but the US infant mortality rate is 36th in the global rankings5. Clearly, overall healthcare spend and care delivery prowess are not the only terms in the equation.

Additional factors significantly impact how healthcare spend is allocated; a few diseases comprise the bulk of healthcare expenditures and 5% of the population account for almost half of every healthcare dollar spent annually (and two-thirds of these expenditures are by those over 50 years old), significant variations in spending can also be mapped by regional, race and socio-economic status - even diet has a major impact (we also happen to be the most obese nation on the planet). In essence, just throwing money at the problem will not fix it. Until recently, the vast majority of studies that identified these issues were done in research settings by care delivery providers or by policy-reviewers at a macro-level with their findings published but not prescriptive - not applied in a way that impacts patients as consumers, not guiding the decisions of how much and when payers should reimburse or which treatments should be offered by care delivery providers. The reason for this is simple: IT technology has been applied in very sophisticated ways to deliver better care but not in a way that makes the cost and decisions as to when and how to deliver it more efficient and transparent. This White Paper provides an Information Technology approach that can deliver the situational awareness and decision support necessary for the healthcare industry reform movement to meet the challenges and opportunities faced by a country with the greatest healthcare infrastructure and largest expenditures in the world to deliver more effective care delivery across a broader patient community. This paper also highlights two case studies that demonstrate how technology can serve as a key component of effective healthcare delivery by creating the necessary data framework for practicing evidencebased medicine (EBM). The theory behind EBM is one in which caregivers ...